External Rotation Exercises Research Articles

Shoulder and Scapular Muscle Activity During Low and High Plank Variations With Different Body-Weight-Bearing Statuses.

Can, EN, Harput, G, and Turgut, E. Shoulder and scapular muscle activity during low and high plank variations with different body-weight-bearing statuses. J Strength Cond Res 38(2): 245-252, 2024-This study investigated the activation levels and activation ratios of shoulder and scapular muscles during low plank (LP) and high plank (HP) variations, with varying levels of body-mass support, including 4-point, 3-pod, and 2-point body-weight-bearing (BWB) statuses. The study was conducted with 21 healthy men (mean ± SD , 26 ± 6.5 years of age and 24.4 ± 2.4 kg·m -2 BMI). Ten different plank exercises were performed in a mixed order by changing elbow joint positions (LP and HP) and BWB statuses (2-point, 3-pod, and 4-point). Activation levels of the lower trapezius (LT), middle trapezius (MT), upper trapezius (UT), biceps brachii, triceps brachii, infraspinatus, and serratus anterior (SA) muscles were assessed with a surface electromyography device. Results of this study showed that elbow position changes resulted in higher LT ( p = 0.01) and TB ( p = 0.001) activation in HP exercises. In general, it was observed that an increase in BWB status was effective in increasing activation for the scapula and shoulder girdle muscles. The ratios of the UT muscle to the SA, LT, and MT muscles were less than 1 during side plank, bird dog, front reach, shoulder taps, and plank with shoulder external rotation exercises. High plank with toe touch exercise resulted in a marked increase in the UT activation. Therefore, it was concluded plank variations alter activation levels and activation ratios of shoulder and scapular muscles. Plank exercises may be used in shoulder rehabilitation and the progression in plank variations can be achieved by changing elbow position and BWB status based on individual requirements.

Enhancing Shoulder External Rotator Electromyography Activity During Sitting External Rotation Exercise: The Impact of Biofeedback Training

Enhancing Shoulder External Rotator Electromyography Activity During Sitting External Rotation Exercise: The Impact of Biofeedback Training

The Effects of Body Positions and Abduction Angles on Shoulder Muscle Activity Patterns during External Rotation Exercises.

Excess and repetitive glenohumeral external rotation (ER) is at a higher risk for shoulder injuries, which occurs frequently in professional sports and specific occupations. Current rehabilitation programs emphasize selective targeting of muscle activity, which can help restore dysfunctional muscle imbalances or prevent injuries. However, the impact of different body postures on GH muscle activity during ER exercises has not been fully understood. Therefore, the purpose of this study was to investigate shoulder EMG activity for different body positions and humeral abduction angles during ER exercises. Twenty-three healthy young men (age: 22.3 ± 2.3, height: 175.75 ± 4.02, mass: 75.37 ± 9.14) participated in this study. Surface Electromyography was recorded from seven shoulder muscles: upper trapezius, lower trapezius, serratus anterior, infraspinatus, and deltoid. Six ER exercises: three postures (sitting, supine lying, and prone lying) and two abduction angles (ABD; 45° and 90°) were tested using an isokinetic dynamometer. During a sitting position, the lower trapezius/upper trapezius muscle activity ratios were significantly increased for sitting compared to supine lying and prone lying (p < 0.001, p = 0.004). Serratus anterior/upper trapezius co-contraction indices were significantly increased for 90° than 45° ABD (p < 0.001). These findings can provide insight into new training programs aimed at restoring GH muscle imbalances.

The influence of shoulder position during multi-joint exercises in the relative scapular muscles activity in symptomatic and asymptomatic conditions.

Scapular muscles changes, as increased upper trapezius activity and decreased middle and lower trapezius and serratus anterior muscle activity, have been demonstrated in shoulder pain specific or non-specific conditions. Shoulder external rotation exercises have been recommended to improve scapular activity in shoulder pain. To evaluate the relative scapular muscles activity during multi-joint exercises combining shoulder external rotation, trunk rotation and scapular squeeze. Forty-one participants with and without shoulder pain were assessed in a cross-sectional study. They performed isometric multi-joint exercises at 0∘ and 90∘ of shoulder abduction with and without support. The relative activity of upper, middle, and lower trapezius and serratus anterior (upper/middle and lower portions) was measured through electromyography. The scapular muscular balance was assessed by the ratio between relative activity of the upper trapezius and the other muscles. Both groups presented similar results. The exercise at 90∘ abduction led to increased relative muscle activity against maximal voluntary contraction in both groups for upper trapezius (with support: 4% MVIC, p= 0.001 or 15% MVIC, p< 0.0001; and without support: 11% MVIC, p< 0.0001 or 13%, p< 0.0001, for asymptomatic and symptomatic group, respectively) and lower trapezius (with support: 66% MVIC, p< 0.0001 or 62% MVIC, p< 0.0001, for asymptomatic and symptomatic group.

Effect of 8-week Shoulder External Rotation Exercise with Low Intensity and Slow Movement on Infraspinatus.

Generally, low-intensity training is recommended as selective training of the infraspinatus muscle. This study aimed to investigate whether an 8-week intervention of low-intensity, slow-movement, external rotation exercise of the shoulder led to an increase in muscle strength with shoulder external rotation and cross-sectional area (CSA) infraspinatus muscle. Sixteen healthy male volunteers were randomly assigned to the low-intensity and slow-movement (LS) group (N = 8) or the normal-intensity and normal-speed (NN) group (N = 8). The LS and NN groups performed shoulder external rotation exercises with low intensity and slow movement, and normal intensity and normal speed, respectively. The exercise session consisted of three sets of 10 repetitions, which were performed three times per week for 8 weeks. We measured the CSA of the infraspinatus and muscle strength of the shoulder external rotation before and after the 8-week intervention. A significant increase in infraspinatus CSA from baseline to 8 weeks was found in the LS group (7.3% of baseline) but not in the NN group. No significant differences were found in the muscle strength of shoulder external rotation. Our results suggest that low-intensity exercise of the infraspinatus is effective for muscle hypertrophy when performed with slow movement. This finding may help patients who should avoid excessive stress in the early phase of rehabilitation.

Appropriate Resistance Intensity for Activation of Infraspinatus and Control of Anterior Translation of the Humeral Head

Background In general, external rotation (ER) exercises are commonly used in rotator cuff retraining programs to improve stabilization ability. ER exercises at 90° of shoulder abduction are common and effective in strengthening the infraspinatus (ISP). However, if the ISP is weak during ER at 90° shoulder abduction, the posterior deltoid muscle (PD) is overactivated, which can lead to anterior translation of the humeral head. Therefore, the selective activation of ISP muscles is an important factor in rehabilitation. Objectives We investigated the muscle activities of the ISP, PD, and middle trapezius (MT), the ratio of the ISP to PD muscle activities, and the anterior translation of the humeral head in response to three resistance intensities during sitting external rotation (SITER) exercises. Methods A total of 12 healthy women recorded changes in the anterior translation of the humeral head using a load cell, the muscle activities of the ISP, PD, and MT, the ratio of the ISP to PD muscle activities using surface electromyography (EMG) during SITER under three different intensities [low (10-20%) medium (45-55%) high (60-70%)]. Results The ISP, PD, and MT amplitudes were highest at high intensity, followed by medium and low intensities during SITER (p < 0.001). The muscle activity ratio was significantly highest at medium intensity compared with low and high intensities (p = 0.031). The anterior translation of the humeral head was highest at high intensity, followed by medium and low intensities during SITER (p < 0.001). Conclusions Medium intensity (45-55%) was the most appropriate intensity during the SITER exercise. However, anterior gliding of the humeral head was the lowest at low intensity. Therefore, during ER exercises, we should think about how to control the anterior gliding of the humeral head.

Open reduction and internal fixation of Ideberg type IA glenoid fractures: Tricks, pearls, and potential pitfalls based on a retrospective cohort of 33 patients focusing on the rehabilitation protocol.

The standard treatment of anterior glenaoid fractures carrying > 20% of the glenoid fossa is open reduction and internal fixation (ORIF). In the herein study, we report our outcomes in a retrospective cohort of anterior and anteroinferior glenoid rim fractures using an accelerated postoperative rehabilitation protocol. A secondary aim is to describe the surgical steps for ORIF of anterior and anteroinferior glenoid rim fractures using the anterior axillary approach, describing the tricks, pearls, and pitfalls of this surgical technique. A retrospective cohort of skeletally mature patients treated for an anterior glenoid rim fracture carrying > 20% of the glenoid fossa during a 10-year period were operated on using a vertical axillary incision, osteosynthesis with 2.0-mm cortical screws, and labral repair with small diameter metallic anchors and non-absorbable sutures. Rehabilitation began on the first postoperative day, including passive external rotation exercises and active-assisted flexion, adduction, and abduction exercises as tolerated. The exercises are performed with the patient sitting or lying down. Phase 1 is continued for 6-10weeks until the patient regains painless, normal, or near-normal ROM. Usually by 10weeks, the fracture and labrum are healed, so phase 2 rehabilitation begins with strengthening and ROM exercises. Radiologic and clinical outcomes, including active range of motion (ROM), glenohumeral stability, and visual analogue scale (VAS) were measured. About 33 patients (35 fractures) had complete medical records and pre- and post-operative imaging exams available for further analysis regarding the surgical protocol, with a mean of 4.8years. The mean DASH questionnaire was 3.75 ± 9.0 and the mean CM score was 62.5 ± 0.1. Active flexion and internal rotation were recovered in all patients, while external rotation presented an average loss of 8° (p = 0.12) and abduction of 5° (p = 0.33). The mean VAS was 1.1 ± 0.8. No patient reported major or disabling symptoms, or great difficulty or inability to perform daily or recreational activities. No patient presented residual instability of the glenohumeral joint. In this retrospective cohort, ORIF using a vertical axillary incision, osteosynthesis with 2.0-mm screws, and labral repair with small diameter metallic anchors and non-absorbable sutures was a safe approach, with a minimal risk of complications and residual instability. The accelerated postoperative rehabilitation protocol, allowing immediate passive external rotation of the operated shoulder, resulted in a non-significant loss of ROM compared to the contralateral side. Therefore, we recommend this management strategy for anterior glenoid rim fractures in patients with unstable shoulder joint after traumatic glenohumeral dislocation. Therapeutic Study (Surgical technique and Retrospective cohort).

Comparison of Infraspinatus and Posterior Deltoid Muscle Activities According to Exercise Methods and Forearm Positions During Shoulder External Rotation Exercises

Comparison of Infraspinatus and Posterior Deltoid Muscle Activities According to Exercise Methods and Forearm Positions During Shoulder External Rotation Exercises

Regional Electromyography of the Infraspinatus and Supraspinatus Muscles During Standing Isometric External Rotation Exercises.

Background:Whole-muscle electromyography (EMG) data of the rotator cuff support external rotation (ER) strengthening exercises during shoulder rehabilitation. However, distinct neuroanatomic regions in the supraspinatus and infraspinatus exist. Differences in regional muscle activity occur during rehabilitation exercises, but little information is available for ER exertions.Hypothesis:Regional infraspinatus and supraspinatus muscle activity during standing ER exertions will differ with posture and intensity.Study Design:Descriptive laboratory study.Level of Evidence:Level 5.Methods:Twenty healthy individuals (12 men, 8 women) participated. Fine wire electrodes were inserted into 2 supraspinatus and 3 infraspinatus muscle regions. EMG data were recorded during standing isometric ER exertions at 2 intensities (maximal, submaximal) and in 7 postures defined by the angle (0°, 30°, 90°) and plane (abduction, scaption, flexion) of arm elevation. EMG data were normalized to maximum voluntary isometric contraction (% MVIC) to examine the influences of posture, intensity and their interaction on muscle activity.Results:Superior infraspinatus activity was higher in 0° of elevation (50.9% ± 5.7% MVIC) versus 30° of flexion (37.4% ± 3.9% MVIC) at maximal intensity. Inferior infraspinatus activity was higher in 90° of scaption (max = 59.8% ± 2.8% MVIC, submax = 29.4% ± 1.9% MVIC) versus 0° of elevation (max = 42.3% ± 4.5% MVIC, submax = 22.4% ± 2.8% MVIC) (P = 0.02, P = 0.05, respectively). Anterior supraspinatus activity was highest in 90° of adbuction (max = 61.6% ± 3.1% MVIC; submax = 39.1% ± 3.8% MVIC) and lowest in 30° of flexion (max = 29.0% ± 3.4% MVIC, submax = 15.6% ± 1.7% MVIC) and 90° of flexion (max = 34.6% ± 2.4% MVIC, submax = 14.8% ± 1.9% MVIC). Posterior suprasptinatus activity was lowest in 0° of elevation (34.2% ± 3.0% MVIC), 30° of flexion (33.0% ± 3.6% MVIC) and highest in 90° of abduction (56.2% ± 4.1% MVIC) and 90° of scaption (46.7% ± 2.8% MVIC) (all Ps < 0.04).Conclusion:Regional infraspinatus and supraspinatus muscle activity differed with posture and intensity. Superior and middle infraspinatus muscle activities were similar across postures, but inferior infraspinatus activity was highest in 90° of arm elevation. Anterior and posterior supraspinatus activities were higher in the abduction and scaption planes, especially at 90° of elevation, as compared with the flexion plane.Clinical Relevance:In shoulder rehabilitation of supraspinatus tendon injuries, ER exercises in the flexion plane challenge the whole infraspinatus muscle and require lower supraspinatus muscle activity.

Effect of Adduction During Glenohumeral External Rotation Exercises in the Scapulohumeral Muscles

Effect of Adduction During Glenohumeral External Rotation Exercises in the Scapulohumeral Muscles

Activation of the gluteus maximus, gluteus medius and tensor fascia lata muscles during hip internal and external rotation exercises at three hip flexion postures

BackgroundHip internal and external rotation exercises are usually performed in clinical practice. However, given the synergies required to stabilize the hip in the frontal plane, it is not clear how the activation of target muscles will differ between the two exercise directions. ObjectiveI) Compare the activation of the upper and lower fibers of gluteus maximus (GMax), gluteus medius (GMed) and tensor fascia lata muscles between the hip internal and external rotation exercises; ii) Compare the maximal isometric force between hip internal and external rotation exercises and; iii) Assess the effect of varying hip flexion angles on muscle activation and maximal isometric force. Study designA cross sectional study. MethodsElectromyography and force production of twenty-one participants were measured during maximum isometric hip internal and external rotation in three postures: 0°, 45° and 90° of hip flexion. ResultsMANOVA results showed a larger activation of the GMed, tensor fascia lata and upper GMax (p < .001) for hip internal rotation compared to external rotation regardless of hip flexion angle. For the lower GMax, the same was observed when the hip was kept at 90° of flexion. Maximal isometric force during hip external rotation was greater than during hip internal rotation at 0° posture, and lower at 90° posture (p < .001). ConclusionThe gluteus and the tensor fascia lata muscles were substantially recruited during the hip internal rotation exercise, and barely recruited during the hip external rotation exercise. Hip flexion influences the myoeletric activity and isometric force production during the internal rotation exercise.

Kinect-based integrated physiotherapy mentor application for shoulder damage

With the increasing rate of disabled people in the world, the number of people in need of physiotherapy is increasing. Most of the disabled persons with shoulder damaged should do physiotherapy exercises. The telerehabilitation systems using developed technologies have advantages over conventional physiotherapy methods. Such systems have the potential to improve communication between patients and physiotherapists. They also allow for easier information and medical data sharing. In this study, a telerehabilitation system based on Kinect Sensor (Kinect 2) was developed to observe and evaluate shoulder damaged patient exercises by using the Kinect skeletal monitoring feature. The proposed system consists of two basic components: the web application that enables the communication between patients and physiotherapists, allows the physiotherapist to observe/update patient exercise data, patients information, and the console application which enables the patients to perform their exercises correctly. This console app was developed for patients with shoulder damage. Abduction, flexion, internal rotation, external rotation, extension exercises can be performed correctly thanks to the developed application. The proposed system was evaluated in Bilecik State Hospital for 29 shoulder damaged volunteers. 14 of the volunteers were treated with the conventional methods and 15 of them were treated with the proposed system. The recovery of the volunteers was analyzed for each intragroup and intergroup comparison was made. Statistically, significant decreases were observed in the limitations of the patients treated with the proposed system. For abduction, flexion, internal rotation, and external rotation exercises, the Kinect-based physiotherapy mentor application was more successful than conventional method, while all volunteers treated by the proposed method had no limitations in extension exercise. As a result, the Kinect-based physiotherapy mentor application can be used as an alternative telerehabilitation method for patients with shoulder damaged.

Examining Muscle Activity Differences During Single and Dual Vector Elastic Resistance Exercises.

BackgroundElastic resistance exercise is a common part of rehabilitation programs. While these exercises are highly prevalent, little information exists on how adding an additional resistance vector with a different direction from the primary vector alters muscle activity of the upper extremity.PurposeThe purpose of this study was to examine the effects of dual vector exercises on torso and upper extremity muscle activity in comparison to traditional single vector techniques.Study DesignRepeated measures design.MethodsSixteen healthy university-aged males completed four common shoulder exercises against elastic resistance (abduction, flexion, internal rotation, external rotation) while using a single or dual elastic vector at a fixed cadence and standardized elastic elongation. Surface electromyography was collected from 16 muscles of the right upper extremity. Mean, peak and integrated activity were extracted from linear enveloped and normalized data and a 2-way repeated measures ANOVA examined differences between conditions.ResultsAll independent variables differentially influenced activation. Interactions between single/dual vectors and exercise type affected mean activation in 11/16 muscles, while interactions in peak activation existed in 7/16 muscles. Adding a secondary vector increased activation predominantly in flexion or abduction exercises; little changes existed when adding a second vector in internal and external rotation exercises. The dual vector exercise in abduction significantly increased mean activation in lower trapezius by 25.6 ± 8.11 %MVC and peak activation in supraspinatus by 29.4 ± 5.94 %MVC (p<0.01). Interactions between single/dual vectors and exercise type affected integrated electromyography for most muscles; the majority of these muscles had the highest integrated electromyography in the dual vector abduction condition.ConclusionMuscle activity often increased with a second resistance vector added; however, the magnitude was exercise-dependent. The majority of these changes existed in the flexion and abduction exercises, with little differences in the internal or external rotation exercises.Level of Evidence3b

Instructional Cueing Alters Upper Limb Muscle Activity and Kinematics During Elastic Resistance Exercise.

The purpose of this study was to quantify the differences in upper limb muscle activity and kinematics when performing shoulder elastic resistance exercises with no cue, slouched posture, and corrected posture. Fifteen healthy participants completed four shoulder elastic resistance exercises (unilateral flexion, bilateral flexion, external rotation, and external rotation with towel) across three simulated body postures (no cue, corrected posture, and slouched posture). Surface electromyography was measured on 16 upper limb muscles and kinematics were collected. Two-way repeated-measures analyses of variance examined differences in muscle activation and kinematics across postures and exercises. Interactions between exercise and posture were found for most muscles. Muscle activity interactions existed in 14 of the 16 muscles examined, with 8 muscles having the greatest activity in the unilateral flexion, slouched condition (P < 0.0001). The slouched posture generated activity up to 88.4 ± 5.1 %MVC in the cervical extensors. Completing flexion or external rotation exercises with a slouched posture led to increased glenohumeral range of motion (P < 0.0001), but these differences were less than 5 degrees between the greatest and smallest ranges of motion (85.8 vs. 81.0 degrees). Posture influenced muscle activation and kinematics, with slouched postures increasing muscle activity and range of motion. There was little to no difference between the no cue and corrected cue conditions, suggesting that perhaps a clinician's time may be better spent focusing on avoiding slouched postures rather than ensuring mastering technique.

The effects of a humeral head posterior gliding strategy on changes in muscle activities of the infraspinatus during external rotation of the shoulder

Background/aims It is important that shoulder rehabilitation programmes incorporate exercises that selectively activate the infraspinatus. In this study, changes in infraspinatus and posterior deltoid electromyography activity during a sitting external rotation exercise with and without the use of a humeral head posterior gliding strategy were investigated. Methods A total of 12 healthy men participated in this study. The activity of the infraspinatus and posterior deltoid was measured during the sitting external rotation exercise, performed with and without humeral head posterior gliding. Differences in the electromyography activity of the infraspinatus and posterior deltoid, with and without humeral head posterior gliding, were analysed using paired t-tests. Results Infraspinatus activity was significantly higher with humeral head posterior gliding than without it (P&lt;0.001). Conversely, posterior deltoid activity was significantly lower with humeral head posterior gliding compared to without it (P&lt;0.001). Conclusions Based on these results, humeral head posterior gliding is recommended for the selective activation of the infraspinatus when performing shoulder external rotation exercises, with the shoulder abducted at 90°.

Changes in Shoulder Muscle Activities Depending on Static and Dynamic Body Positions during Shoulder External Rotation Exercises Using Kinetic Chain Concept

Changes in Shoulder Muscle Activities Depending on Static and Dynamic Body Positions during Shoulder External Rotation Exercises Using Kinetic Chain Concept

PERCEIVED SELF-REPORT OF EFFORT DURING ROTATOR CUFF & SCAPULAR REHABILITATIVE EXERCISE IN PATIENTS AFTER SHOULDER SURGERY.

Rehabilitation following shoulder surgery involves the use of resistive exercise but dosing of these -exercises historically employs multiple sets of pre-determined repetitions and few reports document the perceived effort encountered by patients during these exercises for both elastic resistance and free-weights. The OMNI-Resistance Exercise Scale (OMNI-RES) has been tested and applied as a measure of perceived exertion (RPE) for resistive exercise but has not gained widespread acceptance as an optimal method for physical therapists to document RPE during rehabilitation of shoulder surgery. To generate descriptive values of RPE encountered during common shoulder exercises of varying resistance in patients following shoulder surgery as well as provide a comparative analysis between perceived exertion ratings of similar exercise movement patterns using elastic and traditional isotonic resistance. Descriptive Cross-sectional Cohort. Sixty-six subjects (mean age 53.3 + 12.8 years) were included in this study following shoulder surgery (RC repair n=22, labral repair n=10, SA n=34). Perceived exertion using the OMNI-RES was recorded during performance of seven rotator cuff and scapular rehabilitation exercises at 6- and 12-weeks following surgery. Mean RPE using OMNI-RES in combined surgical groups ranged between 3.6 and 5.7 (mean = 4.50 + 2.1) across all seven exercises (scale 0 = very easy to 10 = extremely hard). From the external rotation (ER) exercise pair, paired t-tests revealed standing ER w/ Thera-band® (ERB) had a significantly higher OMNI-RES score versus sidelying ER w/ cuff weight (SLERW) (mean: 5.13 vs 4.41, p = 0.001) while the extension exercise pair consisting of standing shoulder extension w/ band (EXTB) and prone extension w/ cuff weight (PEXTW) showed no significant difference in OMNI-RES score (mean: 3.54, 3.67, p = 0.626). Commonly prescribed resistance exercise in the rehabilitation following shoulder surgery show light-moderate ratings of perceived exertion at both 6 & 12 week post-operative timepoints across three surgical procedures. 3b.

Strategies for controlling axial shoulder rotation change shoulder muscle activity during external rotation exercises

The infraspinatus muscle has a crucial role in shoulder stability. Although axial shoulder rotation is useful for selective activation of the infraspinatus, no study has examined the influence of exercise position on axial shoulder rotation during shoulder external rotation (ER) exercises. Thus, this study investigated the muscle activity in the infraspinatus, posterior deltoid, and middle trapezius during shoulder ER exercises performed with and without controlled axial shoulder rotation in 2 different positions. Twenty healthy subjects performed prone external rotation (PER) exercises with and without pressure biofeedback and seated external rotation (SITER) exercises with and without posterior humeral head gliding. Muscle activity during each ER exercise was measured using surface electromyography. Exercise strategy (P < .001) and position (P < .001) had a significant main effect on muscle activity in the infraspinatus and posterior deltoid. However, no significant interaction between strategy and position was observed. For muscle activity in the middle trapezius, strategy and position had a significant interaction effect (P = .014). Muscle activity in the infraspinatus increased significantly with the use of strategies to control axial shoulder rotation, whereas muscle activity in the posterior deltoid and middle trapezius decreased significantly. For all 3 muscles, greater activity was observed in the prone position than the seated position. We suggest that PER with pressure biofeedback can be useful to improve selective activation of the infraspinatus muscle while further eliciting infraspinatus muscle activity.

Effect of low-intensity and slow-movement shoulder external rotation exercise on muscle contraction characteristics in the infraspinatus muscle

Effect of low-intensity and slow-movement shoulder external rotation exercise on muscle contraction characteristics in the infraspinatus muscle

Blood Flow Restriction Training for the Rotator Cuff: A Randomized Controlled Trial.

Blood flow restriction (BFR) training utilizes a tourniquet, applied to the proximal portion of one or more extremities, to occlude blood flow during exercise. Significant gains in strength and cross-sectional area can be achieved in muscles, both distal and proximal to BFR cuff application. To compare strength gains of the rotator cuff and changes in tendon size in subjects who performed side-lying external-rotation exercise with or without BFR. Forty-six subjects (mean age 25.0 [2.2]y) were randomized to either a BFR + exercise group or to the exercise-only group. Subjects performed 4 sets of the exercise (30/15/15/15 repetitions) at 30% 1-repetition maximum 2 days per week for 8 weeks. Subjects in both groups experienced strength gains in the supraspinatus and the external rotators (P = .000, P = .000). However, there was no difference in strength gains between groups for the supraspinatus (P = .750) or the external rotators (P = .708). Subjects in both groups experienced increases in supraspinatus tendon thickness (BFRP = .041, exercise onlyP = .011). However, there was no difference between groups (P = .610). Exercise with BFR applied to the proximal upper extremity did not augment rotator cuff strength gains or tendon thickness when compared with subjects who only exercised. This study did demonstrate that performing multiple sets of high repetitions at a low load led to significant increases in rotator cuff strength and tendon size in the dominant upper extremity.